Clinical InvestigationRelationships Between Illness Perceptions, Coping and Psychological Morbidity in Kidney Transplants Patients☆
Introduction
Impaired kidney function, or chronic kidney disease, is increasing in prevalence in our community. In some cases of chronic kidney disease, the loss of kidney function is progressive leading to permanent kidney failure, or end-stage kidney disease (ESKD), when life-sustaining renal replacement therapy is required, either in the form of dialysis or kidney transplantation (KT). Incident and prevalence rates of ESKD vary worldwide1 as does the rate of KT in these groups. KT is accepted as the best form of treatment for those with ESKD without contraindications, allowing improved life expectancy, quality of life (QoL) and reduced cost to the community.2 In spite of the marked benefits of life with a kidney transplant over that of long-term dialysis, patients with post-KT still experience ongoing health-related problems such as medication-related side-effects, pain, sleeping difficulties and sexual dysfunction3; hence, the problem that many KT recipients have ongoing psychological symptoms. It is well documented that dialysis patients experience higher levels of psychological distress than healthy controls, with approximately 20–30% of patients experiencing depression4 and 38% of patients suffering from anxiety.5 ESKD has also been shown to be related to poorer QoL.6, 7 Post-KT cohorts have also been shown to experience ongoing anxiety and depression,3, 8 and although they may experience better post-KT QoL, overall QoL is still lower than the general population.9, 10, 11
Several factors are likely to be associated with QoL and illness outcomes in patients with KT, including individual illness perceptions and coping styles. Leventhal and Meyer12 have identified several aspects of illness perceptions, including identity (medical diagnosis and related symptoms), consequences (how the illness is perceived to effect a person’s physical, social and psychological well-being), causes (factors relating to the onset or have an effect on the illness), timeline (whether it is a chronic, acute or cyclical illness) and cure or control (perceptions of whether the illness can be controlled or cured). Patients with ESKD with poorer illness perceptions report reduced QoL13, 14, 15 and in turn increased psychological distress.16 Similarly, KT cohorts with more negative illness perceptions have also been shown to report reduced QoL and increased psychological distress.17, 18
Individual coping patterns have also been identified to mediate illness outcomes19, 20 For example, Patients with KT who employ avoidance or maladaptive coping styles (eg, wishing the problem away) have poorer QoL and increased psychological distress whereas adaptive focused (primarily emotion based) coping styles (eg, problem solving, getting advice from others) are associated with improved QoL and reduced psychological distress.21, 22, 23
The Common Sense Model (CSM), developed by Leventhal and Meyer,12 provides a theoretical framework explaining the interrelationships between illness status, illness perceptions, coping styles and illness outcomes (including anxiety and depression). The CSM suggests that an individual’s illness status has a direct effect on illness perceptions. Subsequently, illness perceptions have a direct effect on an individual’s coping styles and illness outcomes, whereas coping styles also mediate the relationship between illness perceptions and illness outcomes. Numerous chronic illness studies have provided evidence that for the efficacy of the CSM.24 However, the utility of the CSM in patients with KT has not hitherto been evaluated.
The aim of the current study was to explore the utility of the CSM in a group of kidney transplant patients. We hypothesized that poorer health status, illness perceptions and increased engagement in maladaptive coping would be adversely associated with psychological distress (specifically anxiety and depression) and poorer QoL. It was also hypothesized that adaptive problem-focused and emotion-focused coping styles would be associated with lower psychological distress (specifically anxiety and depression) and QoL. Finally, it was hypothesized that after accounting for KT characteristics (time since most recent transplant, number of transplants), health status, illness perceptions and coping styles would predict anxiety, depression and QoL.
Section snippets
Participants
A total of 52 individuals (35 men and 17 women) with a mean age of 53.5 years (standard deviation [SD] = 10.77) participated in this study; all were from a large metropolitan hospital transplant unit. The mean time since the most recent KT was 7.02 (SD = 5.59; minimum = 1 year and maximum = 31 years) years. Regarding type of transplant, 29 (55.8%) had a deceased donor transplant, 12 (23.1) had a live related donor transplant, 8 (15.4%) a live unrelated kidney donor transplant and 3 (5.8%) had a
Results
Based on the hospital anxiety and depression scale anxiety and depression scores, 85% and 87% (44 and 45 participants, respectively) within this cohort had normal-to-low symptom levels of anxiety and depression. Overall, 10% (5 participants) had mild symptoms of depression, whereas 4% (2 participants) had moderate symptoms of depression. In regard to anxiety, 6% (3 participants) had mild symptoms, 6% (3 participants) had moderate symptoms and the remaining 4% (2 participants) had severe anxiety
Discussion
This pilot study is unique in exploring the efficacy of the CSM to predict anxiety, depression and QoL in a group of KT patients. The results indicated that most of the participants reported normal-to-low symptom levels of anxiety and depression (85% and 87%, respectively). This result was unexpected, given the past evidence that suggests patients with KT often report ongoing health-related problems,3 anxiety and depression.3, 8 This lower than expected prevalence of psychological burden may be
Conclusions
There is limited research exploring the effect of KT on psychological well-being and QoL. Of the research that has been done, the evidence suggest KT cohort are more likely to report poorer QoL and increased psychological distress. Our pilot study is the first to evaluate these outcome measures within a theoretical framework, specifically the CSM. The finding of the present study emphasizes on the importance of exploring and understanding the effect of illness status and illness perceptions in
References (34)
- et al.
The prevalence of symptoms in end-stage renal disease: a systematic review
Adv Chronic Kidney Dis
(2007) - et al.
Prospective quality-of-life monitoring of simultaneous pancreas and kidney transplant recipients using the 36-item short form health survey
Am J Kidney Dis
(2010) - et al.
Illness representations are associated with fluid nonadherence among hemodialysis patients
J Psychosom Res
(2010) - et al.
Quality of life and psychosocial factors in renal transplant recipients
Transplant Proc
(2006) - et al.
The brief illness perception questionnaire
J Psychosom Res
(2006) - et al.
Social adaptability index predicts overall mortality in patients with diabetes
J Diabetes Complications
(2012) - et al.
Kidney Transplant Working Group of the Canadian Society of T: Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
CMAJ
(2005) - et al.
Distress associated with adverse effects of immunosuppressive medication in kidney transplant recipients
Prog Transplant
(2010) The importance of illness perception in end-stage renal disease: associations with psychosocial and clinical outcomes
Sem Dial
(2012)
Emotional profile and quality of life in chronic renal failure transplant patients
Cogn Brain Behav
Symptom burden and quality of life in end-stage renal disease: a study of 179 patients on dialysis and palliative care
Palliat Med
Prevalence of anxiety and depression in Iranian kidney transplant recipients
Neurosciences
Sleep disorders and quality of life in renal transplant recipients
Int Urol Nephrol
Impact of personality and psychological distress on health-related quality of life in kidney transplant recipients
Transplant Int
The common sense model of illness danger
Illness and treatment cognitions and health related quality of life in end stage renal disease
Br J Health Psychol
Cited by (13)
Psychiatric challenges and management in kidney transplantation
2020, Psychosocial Aspects of Chronic Kidney Disease: Exploring the Impact of CKD, Dialysis, and Transplantation on PatientsPsychopharmacology in transplantation medicine
2019, Progress in Neuro-Psychopharmacology and Biological PsychiatryCitation Excerpt :By the end of 2015, over 10,000 patients were waitlisted in Germany while only <4000 received transplants (2195 kidneys, 894 livers, 286 hearts, 296 lungs, 105 pancreases, and 1 small intestine) (Transplantation, 2018). Despite improvements in long-term survival and morbidity due to surgical innovations and effective immunosuppressants, increasing evidence suggests that psychiatric and behavioral factors affect pre-transplant selection and long-term post-transplant outcomes (Bajaj et al., 2012; Courtwright et al., 2016; Eftekar & Pun, 2016; Gregurek et al., 1996; Iwashige et al., 1990; Karim et al., 2010; Knowles et al., 2016; Kuntz et al., 2015; Madan et al., 2015; Miller-Matero et al., 2016; Molnar-Varga et al., 2016; Mucsi et al., 2017; Naqvi, 2015; Noma et al., 2008; Novak et al., 2010; Pistorio et al., 2013; Pither et al., 2014; Price et al., 2014; Rosenberger et al., 2016; Rustad et al., 2015; Seiler et al., 2015; Shapiro et al., 1995; Shaw et al., 2003; Soyseth et al., 2016; Faeder et al., 2015; Davydow et al., 2015) A recent meta-analysis of 20 studies and over 1000 patients, examining depression or anxiety in relation to clinical outcome, indicates a 65% greater mortality risk among patients with depression (Dew et al., 2015). Furthermore, psychiatric disorders, especially depression, are associated with post-transplant non-adherence and morbidity (Novak et al., 2010; Muller et al., 2015; Rodrigue et al., 2013a).
Depression
2022, Evidence-Based Nephrology, Second Edition: Volumes 1,2
- ☆
The authors have no financial or other conflicts of interest to disclose.